Controlling impedance rise in electrosurgical medical devices

ABSTRACT

Various embodiments are directed to electrosurgical systems for providing an electrosurgical signal to a patient. A control circuit may, for a first application period, apply the electrosurgical signal to first and second electrodes according to a first mode. In the first mode, the control circuit may limit the electrosurgical signal to a first maximum power when the impedance between the first and second electrodes exceeds a first mode threshold. The control circuit may also, for a second application period after the first application period, apply the electrosurgical signal according to a second mode. In the second mode, the control circuit may limit the electrosurgical signal to a second mode maximum power when the impedance between the first and second electrodes exceeds a second mode threshold. The second maximum power may be greater than the first maximum power.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application claiming priority under35 U.S.C. § 120 to U.S. patent application Ser. No. 15/667,225, entitledCONTROLLING IMPEDANCE RISE IN ELECTROSURGICAL MEDICAL DEVICES, filed onAug. 2, 2017, now U.S. Patent Application Publication No. 2018/0036061,which is a divisional application claiming priority under 35 U.S.C. §121 to U.S. patent application Ser. No. 14/230,349, entitled CONTROLLINGIMPEDANCE RISE IN ELECTROSURGICAL MEDICAL DEVICES, filed on Mar. 31,2014, which issued on Aug. 22, 2017 as U.S. Pat. No. 9,737,355, theentire disclosures of which are hereby incorporated by reference herein.

BACKGROUND

Electrosurgical instruments are a type of surgical instrument used inmany surgical operations. Electrosurgical instruments apply electricalenergy to tissue in order to treat tissue. An electrosurgical instrumentmay comprise an instrument having a distally-mounted end effectorcomprising one or more electrodes. The end effector can be positionedagainst tissue such that electrical current is introduced into thetissue. Electrosurgical instruments can be configured for bipolar ormonopolar operation. During bipolar operation, current is introducedinto and returned from the tissue by active and return electrodes,respectively, of the end effector. During monopolar operation, currentis introduced into the tissue by an active (or source) electrode of theend effector and returned through a return electrode (e.g., a groundingpad) separately located on a patient's body. Heat generated by thecurrent flow through the tissue may form hemostatic seals within thetissue and/or between tissues and thus may be particularly useful forsealing blood vessels, for example. The end effector of anelectrosurgical instrument sometimes also comprises a cutting memberthat is moveable relative to the tissue and the electrodes to transectthe tissue.

Electrical energy applied by an electrosurgical instrument can betransmitted to the instrument by a generator. The generator may form anelectrosurgical signal that is applied to an electrode or electrodes ofthe electrosurgical instrument. The generator may be external orintegral to the electrosurgical instrument. The electrosurgical signalmay be in the form of radio frequency (“RF”) energy. For example, RFenergy may be provided at a frequency range of between 100 kHz and 1MHz. During operation, an electrosurgical instrument can transmit RFenergy through tissue, which causes ionic agitation, or friction, ineffect resistive heating, thereby increasing the temperature of thetissue. Because a sharp boundary may be created between the affectedtissue and the surrounding tissue, surgeons can operate with a highlevel of precision and control, without sacrificing un-targeted adjacenttissue. The low operating temperatures of RF energy may be useful forremoving, shrinking, or sculpting soft tissue while simultaneouslysealing blood vessels. RF energy may work particularly well onconnective tissue, which is primarily comprised of collagen and shrinkswhen contacted by heat.

During the application of RF energy to tissue, the impedance of thetissue indicates the condition of the tissue. What is needed are methodsand systems for managing the impedance of tissue during the applicationof RF energy to achieve optimal tissue treatment.

SUMMARY

Various embodiments are directed to electrosurgical systems forproviding an electrosurgical signal to a patient. A control circuit may,for a first application period, apply the electrosurgical signal tofirst and second electrodes according to a first mode. In the firstmode, the control circuit may limit the electrosurgical signal to afirst maximum power when the impedance between the first and secondelectrodes exceeds a first mode threshold. The control circuit may also,for a second application period after the first application period,apply the electrosurgical signal according to a second mode. In thesecond mode, the control circuit may limit the electrosurgical signal toa second mode maximum power when the impedance between the first andsecond electrodes exceeds a second mode threshold. The second maximumpower may be greater than the first maximum power.

FIGURES

The features of the various embodiments are set forth with particularityin the appended claims. The various embodiments, however, both as toorganization and methods of operation, together with advantages thereof,may best be understood by reference to the following description, takenin conjunction with the accompanying drawings as follows:

FIG. 1 shows a perspective view of one example embodiment of a surgicalsystem comprising an electrosurgical instrument and an externalgenerator.

FIG. 2 shows a side view of one example embodiment of the handle of thesurgical instrument of FIG. 1 with half of a first handle body removedto illustrate various components within the second handle body.

FIG. 3 shows a perspective view of one embodiment of the end effector ofthe surgical instrument of FIG. 1 with the jaws open and the distal endof an axially moveable member in a retracted position.

FIG. 4 shows a perspective view of one embodiment of the end effector ofthe surgical instrument of FIG. 1 with the jaws closed and the distalend of an axially moveable member in a partially advanced position.

FIG. 5 shows a perspective view of one embodiment of the axiallymoveable member of the surgical instrument of FIG. 1.

FIG. 6 shows a section view of one embodiment of the end effector of thesurgical instrument of FIG. 1.

FIG. 7 shows a perspective view of one example embodiment of a surgicalsystem comprising a cordless electrical energy surgical instrument withan integral generator.

FIG. 8A shows a side view of a handle of one embodiment of the surgicalinstrument of FIG. 7 with half of the handle body removed to illustratevarious components therein.

FIG. 8B shows one embodiment of an RF drive and control circuit.

FIG. 8C shows one embodiment of the main components of a controlcircuit.

FIG. 9 shows one embodiment of a chart showing example power curves thatmay be delivered by an electrosurgical system.

FIG. 10 shows one embodiment of a process flow for applying one or morepower curves to a tissue bite.

FIG. 11 shows one embodiment of a process flow for applying one or morepower curves to a tissue bite.

FIG. 12 shows one embodiment of a process flow for managing tissueimpedance during a treatment cycle utilizing three modes.

FIG. 12a is a chart showing power and impedance characteristics of oneembodiment of a drive signal that may be provided by the generatorduring the first mode of the process flow of FIG. 12.

FIG. 12b is a chart showing power and impedance characteristics of oneembodiment of a drive signal that may be provided by the generatorduring the second mode of the process flow of FIG. 12.

FIG. 12c is a chart showing power and impedance characteristics of oneembodiment of a drive signal that may be provided by the generatorduring the third mode of the process flow of FIG. 12.

FIG. 13 is a chart showing voltage and tissue impedance thresholds thatmay be applied during the first mode according to one embodiment.

FIG. 14 is a chart showing voltage and tissue impedance thresholds thatmay be applied during a second mode according to one embodiment.

FIG. 15 is a chart showing voltage and impedance thresholds for a firstsub-mode of the third mode.

FIG. 16 is a chart showing voltage and impedance thresholds for a secondsub-mode of a third mode.

FIG. 17 is a chart showing voltage and impedance thresholds for a thirdsub-mode of a third mode.

FIG. 18 is a chart showing tissue impedance during one tissue cycleaccording to the process flow of FIG. 12.

FIG. 19 shows one embodiment of a process flow for applying a repeatmode in the context of a surgical system such as those shown above inFIG. 1 and FIG. 7.

FIG. 20 shows an alternate embodiment of the process flow of FIG. 11incorporating a repeat mode.

FIG. 21 shows an alternate embodiment of the process flow of FIG. 12incorporating a repeat mode.

DESCRIPTION

Reference will now be made in detail to several embodiments, includingembodiments showing example implementations of electrosurgicalinstruments for cutting and coagulating tissue. Wherever practicablesimilar or like reference numbers may be used in the figures and mayindicate similar or like functionality. The figures depict exampleembodiments of the disclosed electrosurgical instruments and/or methodsof use for purposes of illustration only. One skilled in the art willreadily recognize from the following description that alternativeexample embodiments of the structures and methods illustrated herein maybe employed without departing from the principles described herein.

Electrosurgical instruments utilize therapeutic and/or subtherapeuticelectrical energy to treat tissue and/or provide feedback to thegenerators. The various electrosurgical instruments described herein areadapted for use in a manual or hand-operated manner, althoughelectrosurgical instruments with the features described herein may beused in robotic applications as well. FIG. 1 shows a perspective view ofone example embodiment of a surgical system 100 comprising anelectrosurgical instrument 110 and an external generator 120. Theelectrosurgical instrument 110 may comprise a proximal handle 112, adistal working end or end effector 126 and an introducer or elongatedshaft 114 disposed in-between.

The electrosurgical system 100 can be configured to supply energy, suchas electrical energy, ultrasonic energy, heat energy, or any combinationthereof, to the tissue of a patient either independently orsimultaneously, for example. In one example embodiment, theelectrosurgical system 100 includes the generator 120 in electricalcommunication with the electrosurgical instrument 110. The generator 120is connected to the electrosurgical instrument 110 via a suitabletransmission medium such as a cable 122. In one example embodiment, thegenerator 120 is coupled to a controller, such as a control unit 125,for example. In various embodiments, the control unit 125 may be formedintegrally with the generator 120 or may be provided as a separatecircuit module or device electrically coupled to the generator 120(shown in phantom to illustrate this option). Although in the presentlydisclosed embodiment, the generator 120 is shown separate from theelectrosurgical instrument 110, in one example embodiment, the generator120 (and/or the control unit 125) may be formed integrally with theelectrosurgical instrument 110 to form a unitary electrosurgical system100, where a battery located within the electrosurgical instrument 110is the energy source and a circuit coupled to the battery produces thesuitable electrical energy, ultrasonic energy, or heat energy. One suchexample is described herein below in connection with FIGS. 7-8C. Thegenerator 120 may comprise an input device 135 located on a front panelof the generator 120 console. The input device 135 may comprise anysuitable device that generates signals suitable for programming theoperation of the generator 120, such as a keyboard, or input port, forexample.

Referring now to the end effector 126, electrodes in the first jaw 164 aand the second jaw 164 b may be coupled to the generator 120 via thehandle 112 and cable 122. The cable 122 may comprise multiple electricalconductors for the application of electrical energy to positive (+) andnegative (−) electrodes of the electrosurgical instrument 110. Forexample, the cable 122 may comprise at least one supply conductor 131and at least one return conductor 133. In various embodiments, thesupply conductor 131 and the return conductor 133 may comprise insulatedwires and/or any other suitable type of conductor. In certainembodiments, as described below, the supply conductor 131 and the returnconductor 133 may be contained within and/or may comprise the cable 122extending between, or at least partially between, the generator 120 andthe end effector 126 of the electrosurgical instrument 110. In anyevent, the generator 120 can be configured to apply a sufficient voltagedifferential between the supply conductor 131 and the return conductor133 such that sufficient current can be supplied to the end effector126.

The control unit 125 may be used to activate the generator 120, whichmay serve as an electrical source. The generator may create anelectrosurgical drive signal provided to the electrodes of the jaws 164a, 164 b via the handle 112. In various embodiments, the generator 120may comprise an RF or electrosurgical source, an ultrasonic source, adirect current source, and/or any other suitable type of electricalenergy source, for example, which may be activated independently orsimultaneously.

FIG. 2 shows a side view of one example embodiment of the handle 112 ofthe surgical instrument 110 with half of a first handle body 112 a (seeFIG. 1) removed to illustrate various components within the secondhandle body 112 b. The handle 112 may comprise a lever arm 121 (e.g., atrigger) which may be pulled along a path 33. The lever arm 121 may becoupled to an axially moveable member 178 (FIGS. 3-6) disposed withinthe elongated shaft 114 by a shuttle 184 operably engaged to anextension 198 of lever arm 121. The shuttle 184 may further be connectedto a biasing device, such as a spring 188, which may also be connectedto the second handle body 112 b, to bias the shuttle 184 and thus theaxially moveable member 178 in a proximal direction, thereby urging thejaws 164 a and 164 b to an open position as seen in FIG. 1. Also,referring to FIGS. 1-2, a locking member 190 (see FIG. 2) may be movedby a locking switch between a locked position, where the shuttle 184 issubstantially prevented from moving distally as illustrated, and anunlocked position, where the shuttle 184 may be allowed to freely movein the distal direction, toward the elongated shaft 114. The handle 112can be any type of pistol-grip or other type of handle known in the artthat is configured to carry actuator levers, triggers or sliders foractuating the first jaw 164 a and the second jaw 164 b. In someembodiments, the handle 112 may comprise a pencil-style handle. Theelongated shaft 114 may have a cylindrical or rectangular cross-section,for example, and can comprise a thin-wall tubular sleeve that extendsfrom handle 112. The elongated shaft 114 may include a bore extendingtherethrough for carrying actuator mechanisms, for example, the axiallymoveable member 178, for actuating the jaws and for carrying electricalleads for delivery of electrical energy to electrosurgical components ofthe end effector 126.

The end effector 126 may be adapted for capturing and transecting tissueand for contemporaneously welding the captured tissue with controlledapplication of energy (e.g., RF energy). The first jaw 164 a and thesecond jaw 164 b may close to thereby capture or engage tissue about alongitudinal axis “T” defined by the axially moveable member 178. Thefirst jaw 164 a and second jaw 164 b may also apply compression to thetissue. In some embodiments, the elongated shaft 114, along with thefirst jaw 164 a and second jaw 164 b, can be rotated a full 360°degrees, as shown by the arrow 196 (see FIG. 1), relative to the handle112. For example, a rotation knob 148 may be rotatable about thelongitudinal axis of the shaft 114 and may be coupled to the shaft 114such that rotation of the knob 148 causes corresponding rotation of theshaft 114. The first jaw 164 a and the second jaw 164 b can remainopenable and/or closeable while rotated.

FIG. 3 shows a perspective view of one example embodiment of the endeffector 126 with the jaws 164 a, 164 b open and the distal end of theaxially moveable member 178 in a retracted position. FIG. 4 shows aperspective view of one embodiment of the end effector 126 with the jaws164 a, 164 b closed and the distal end of the axially moveable member178 in a partially advanced position. As noted above, the end effector126 may comprise the upper first jaw 164 a and the lower second jaw 164b, which may be straight or curved. The first jaw 164 a and the secondjaw 164 b may each comprise an elongated slot or channel 162 a and 162b, respectively, disposed outwardly along their respective middleportions. Further, the first jaw 164 a and the second jaw 164 b may eachhave tissue-gripping elements, such as teeth 163, disposed on the innerportions of the first jaw 164 a and the second jaw 164 b. The first jaw164 a may comprise an upper first jaw body with an upper firstoutward-facing surface 169 a and an upper first energy delivery surface165 a. The second jaw 164 b may comprise a lower second jaw body with alower second outward-facing surface 169 b and a lower second energydelivery surface 165 b. The first energy delivery surface 165 a and thesecond energy delivery surface 165 b may both extend in a “U” shapeabout the distal end of the end effector 126.

The lever arm 121 of the handle 112 (FIG. 2) may be adapted to actuatethe axially moveable member 178, which also may function as ajaw-closing mechanism. For example, the axially moveable member 178 maybe urged distally as the lever arm 121 is pulled proximally along thepath 33 via the shuttle 184, as shown in FIG. 2 and discussed above.FIG. 5 is a perspective view of one example embodiment of the axiallymoveable member 178 of the surgical instrument 110. The axially moveablemember 178 may comprise one or several pieces, but in any event, may bemoveable or translatable with respect to the elongated shaft 114 and/orthe jaws 164 a, 164 b. Also, in at least one example embodiment, theaxially moveable member 178 may be made of 17-4 precipitation hardenedstainless steel. The distal end of axially moveable member 178 maycomprise a flanged “I”-beam configured to slide within the channels 162a and 162 b in jaws 164 a and 164 b. The axially moveable member 178 mayslide within the channels 162 a, 162 b to open and close the first jaw164 a and the second jaw 164 b. The distal end of the axially moveablemember 178 may also comprise an upper flange or “c”-shaped portion 178 aand a lower flange or “c”-shaped portion 178 b. The flanges 178 a, 178 brespectively define inner cam surfaces 167 a and 167 b for engagingoutward facing surfaces of the first jaw 164 a and the second jaw 164 b.The opening-closing of jaws 164 a and 164 b can apply very highcompressive forces on tissue using cam mechanisms which may includemoveable “I-beam” axially moveable member 178 and the outward facingsurfaces 169 a, 169 b of jaws 164 a, 164 b.

More specifically, referring now to FIGS. 3-5, collectively, the innercam surfaces 167 a and 167 b of the distal end of axially moveablemember 178 may be adapted to slidably engage the first outward-facingsurface 369 a and the second outward-facing surface 169 b of the firstjaw 164 a and the second jaw 164 b, respectively. The channel 162 awithin first jaw 164 a and the channel 162 b within the second jaw 164 bmay be sized and configured to accommodate the movement of the axiallymoveable member 178, which may comprise a tissue-cutting element 171,for example, comprising a sharp distal edge. FIG. 4, for example, showsthe distal end of the axially moveable member 178 advanced at leastpartially through channels 162 a and 162 b (FIG. 3). The advancement ofthe axially moveable member 178 may close the end effector 126 from theopen configuration shown in FIG. 3. In the closed position shown by FIG.4, the upper first jaw 164 a and the lower second jaw 164 b define a gapor dimension D between the first energy delivery surface 165 a andsecond energy delivery surface 165 b of the first jaw 164 a and thesecond jaw 164 b, respectively. In various embodiments, dimension the Dcan equal from about 0.0005″ to about 0.040″, for example, and in someembodiments, between about 0.001″ to about 0.010″, for example. Also,the edges of the first energy delivery surface 165 a and the secondenergy delivery surface 165 b may be rounded to prevent the dissectionof tissue.

FIG. 6 is a section view of one example embodiment of the end effector126 of the surgical instrument 110. The second energy delivery surface165 b of the lower jaw 164 b is adapted to deliver energy to tissue, atleast in part, through a conductive-resistive matrix, such as a variableresistive PTC body, as discussed in more detail below. At least one ofthe upper and lower jaws 164 a, 164 b may carry at least one electrode173 configured to deliver the energy from the generator 120 to thecaptured tissue. The first energy delivery surface 165 a of the upperjaw 164 a may carry a similar conductive-resistive matrix (i.e., a PTCmaterial), or in some embodiments the surface may be a conductiveelectrode or an insulative layer, for example. Alternatively, theengagement surfaces of the jaws can carry any of the energy deliverycomponents disclosed in U.S. Pat. No. 6,773,409, filed Oct. 22, 2001,entitled ELECTROSURGICAL JAW STRUCTURE FOR CONTROLLED ENERGY DELIVERY,the entire disclosure of which is incorporated herein by reference.

The first energy delivery surface 165 a and the second energy deliverysurface 165 b each may be in electrical communication with the generator120. The first energy delivery surface 165 a and the second energydelivery surface 165 b may be configured to contact tissue and deliverelectrosurgical energy to captured tissue to seal or weld the tissue.The control unit 125 regulates the electrical energy delivered byelectrical generator 120 which in turn delivers electrosurgical energyto the first energy delivery surface 165 a and the second energydelivery surface 165 b. The energy delivery may be initiated by anactivation button 128 (FIG. 2) operably engaged with the lever arm 121and in electrical communication with the generator 120 via a cable 122.In one example embodiment, the electrosurgical instrument 110 may beenergized by the generator 120 by way of a foot switch 129 (FIG. 1).When actuated, the foot switch 129 triggers the generator 120 to deliverelectrical energy to the end effector 126, for example. The control unit125 may regulate the power generated by the generator 120 duringactivation. Although the foot switch 129 may be suitable in manycircumstances, other suitable types of switches can be used, such as,for example, a thumb switch.

As mentioned above, the electrosurgical energy delivered by electricalgenerator 120 and regulated, or otherwise controlled, by the controlunit 125 may comprise radio frequency (RF) energy, or other suitableforms of electrical energy. Further, the opposing first and secondenergy delivery surfaces 165 a and 165 b may carry variable resistivePTC bodies that are in electrical communication with the generator 120and the control unit 125. Additional details regarding electrosurgicalend effectors, jaw closing mechanisms, and electrosurgicalenergy-delivery surfaces are described in the following U.S. patents andpublished patent applications: U.S. Pat. Nos. 7,087,054; 7,083,619;7,070,597; 7,041,102; 7,011,657; 6,929,644; 6,926,716; 6,913,579;6,905,497; 6,802,843; 6,770,072; 6,656,177; and 6,533,784; and U.S. Pat.App. Pub. Nos. 2010/0036370 and 2009/0076506, all of which areincorporated herein by reference in their entirety and made part of thisspecification.

In one example embodiment, the generator 120 may be implemented as anelectrosurgery unit (ESU) capable of supplying power sufficient toperform bipolar electrosurgery using radio frequency (RF) energy. In oneexample embodiment, the ESU can be a bipolar ERBE VIO 150 sold by ERBEUSA, Inc. of Marietta, Ga. and/or a GEN11 generator sold by EthiconEndo-Surgery of Cincinnati, Ohio. In some embodiments, such as forbipolar electrosurgery applications, a surgical instrument having anactive electrode and a return electrode can be utilized, wherein theactive electrode and the return electrode can be positioned against,adjacent to and/or in electrical communication with, the tissue to betreated such that current can flow from the active electrode, throughthe PTC bodies and to the return electrode through the tissue. Thus, invarious embodiments, the electrosurgical system 100 may comprise asupply path and a return path, where the captured tissue being treatedcompletes, or closes, the circuit. In some embodiments, the operator mayprovide subtherapeutic RF energy levels for purposes of evaluatingtissue conditions and providing feedback in the electrosurgical system100. Such feed back may be employed to control the therapeutic RF energyoutput of the electrosurgical instrument 110.

During operation of electrosurgical instrument 110, the user generallygrasps tissue, supplies energy to the grasped tissue to form a weld or aseal (e.g., by actuating button 128 and/or foot switch 129), and thendrives a tissue-cutting element 171 at the distal end of the axiallymoveable member 178 through the grasped tissue. According to variousembodiments, the translation of the axial movement of the axiallymoveable member 178 may be paced, or otherwise controlled, to aid indriving the axially moveable member 178 at a suitable rate of travel. Bycontrolling the rate of the travel, the likelihood that the capturedtissue has been properly and functionally sealed prior to transectionwith the cutting element 171 is increased.

FIG. 7 shows a perspective view of one example embodiment of a surgicalsystem 200 comprising a cordless electrical energy surgical instrument210 with an integral generator (not shown in FIG. 7). Theelectrosurgical system 200 is similar to the electrosurgical system 100.The electrosurgical system 200 can be configured to supply energy, suchas electrical energy, ultrasonic energy, heat energy, or any combinationthereof, to the tissue of a patient either independently orsimultaneously as described in connection with FIG. 1, for example. Theelectrosurgical instrument 210 may utilize the end effector 126 andelongated shaft 114 described here in conjunction with a cordlessproximal handle 212. In one example embodiment, the handle 212 includesthe integral generator circuit 220 (see FIG. 8A). The generator circuit220 performs a function substantially similar to that of generator 120.In one example embodiment, the generator circuit 220 is coupled to acontroller or control circuit (e.g., 281 in FIG. 8B). In the illustratedembodiment, the control circuit is integrated into the generator circuit220. In other embodiments, the control circuit may be separate from thegenerator circuit 220.

In one example embodiment, various electrodes in the end effector 126(including the first and second jaws 164 a, 164 b thereof) may becoupled to the generator circuit 220. The control circuit may be used toactivate the generator 220, which may serve as an electrical source. Invarious embodiments, the generator 220 may comprise an RF source, anultrasonic source, a direct current source, a microwave source, and/orany other suitable type of thermogenic energy source, for example. Forexample, a direct current source may be utilized to power a heatingelement that could treat tissue. In one example embodiment, a button 228may be provided to activate the generator circuit 220 to provide energyto the end effector 126.

FIG. 8A shows a side view of one example embodiment of the handle 212 ofthe cordless surgical instrument 210 with half of a first handle bodyremoved to illustrate various components within the second handle body234. The handle 212 may comprise a lever arm 221 (e.g., a trigger) whichmay be pulled along a path 33 around a pivot point. The lever arm 221may be coupled to an axially moveable member 278 disposed within theelongated shaft 114 by a shuttle operably engaged to an extension oflever arm 221. In one example embodiment, the lever arm 221 defines ashepherd's hook shape comprising a distal trigger hook 221 a and aproximal trigger portion 221 b. As illustrated, the distal trigger hook221 a may have a first length while the proximal trigger portion 221 bmay have a second length with the second length greater than the firstlength.

In one example embodiment, the cordless electrosurgical instrumentcomprises a battery 237. The battery 237 provides electrical energy tothe generator circuit 220. The battery 237 may be any battery suitablefor driving the generator circuit 220 at the desired energy levels. Inone example embodiment, the battery 237 is a 1030 mAhr, triple-cellLithium Ion Polymer battery. The battery may be fully charged prior touse in a surgical procedure, and may hold a voltage of about 12.6V. Thebattery 237 may have two fuses fitted to the cordless electrosurgicalinstrument 210, arranged in line with each battery terminal. In oneexample embodiment, a charging port 239 is provided to connect thebattery 237 to a DC current source (not shown).

The generator circuit 220 may be configured in any suitable manner. Insome embodiments, the generator circuit comprises an RF drive andcontrol circuit 240 and a controller circuit 282. FIG. 8B shows oneembodiment of an RF drive and control circuit 240. FIG. 8B is a partschematic part block diagram showing the RF drive and control circuitry240 used in this embodiment to generate and control the RF electricalenergy supplied to the end effector 126. In this embodiment, the drivecircuitry 240 is a resonant mode RF amplifier comprising a parallelresonant network on the RF amplifier output and the control circuitryoperates to control the operating frequency of the electrosurgical drivesignal so that it is maintained at the resonant frequency of the drivecircuit, which in turn controls the amount of power supplied to the endeffector 126. The way that this is achieved will become apparent fromthe following description.

As shown in FIG. 8B, the RF drive and control circuit 240 comprises theabove described battery 237 are arranged to supply, in this example,about 0V and about 12V rails. An input capacitor (C_(in)) 242 isconnected between the 0V and the 12V for providing a low sourceimpedance. A pair of FET switches 243-1 and 243-2 (both of which areN-channel in this embodiment to reduce power losses) is connected inseries between the 0V rail and the 12V rail. FET gate drive circuitry245 is provided that generates two drive signals—one for driving each ofthe two FET's 243. The FET gate drive circuitry 245 generates drivesignals that causes the upper FET (243-1) to be on when the lower FET(243-2) is off and vice versa. This causes the node 247 to bealternately connected to the 12V rail (when the FET 243-1 is switchedon) and the 0V rail (when the FET 243-2 is switched on). FIG. 8B alsoshows the internal parasitic diodes 248-1 and 248-2 of the correspondingFET's 243, which conduct during any periods that the FET's 243 are open.

As shown in FIG. 8B, the node 247 is connected to an inductor-inductorresonant circuit 250 formed by inductor L_(s) 252 and inductor L_(m)254. The FET gate driving circuitry 245 is arranged to generate drivesignals at a drive frequency (f_(d)) that opens and crosses the FETswitches 243 at the resonant frequency of the parallel resonant circuit250. As a result of the resonant characteristic of the resonant circuit250, the square wave voltage at node 247 will cause a substantiallysinusoidal current at the drive frequency (f_(d)) to flow within theresonant circuit 250. As illustrated in FIG. 8B, the inductor L_(m) 254is the primary of a transformer 255, the secondary of which is formed byinductor L_(sec) 256. The inductor L_(sec) 256 of the transformer 255secondary is connected to an inductor-capacitor-capacitor parallelresonant circuit 257 formed by inductor L₂ 258, capacitor C₄ 260, andcapacitor C₂ 262. The transformer 255 up-converts the drive voltage(V_(d)) across the inductor L_(m) 254 to the voltage that is applied tothe output parallel resonant circuit 257. The load voltage (V_(L)) isoutput by the parallel resonant circuit 257 and is applied to the load(represented by the load resistance R_(load) 259 in FIG. 8B)corresponding to the impedance of the forceps' jaws and any tissue orvessel gripped by the end effector 126. As shown in FIG. 8B, a pair ofDC blocking capacitors C_(bl1) 280-1 and C_(bl2) 280-2 is provided toprevent any DC signal being applied to the load 259.

In one embodiment, the transformer 255 may be implemented with a CoreDiameter (mm), Wire Diameter (mm), and Gap between secondary windings inaccordance with the following specifications:

Core Diameter, D (mm)

D=19.9×10−3

Wire diameter, W (mm) for 22 AWG wire

W=7.366×10−4

Gap between secondary windings, in gap=0.125

G=gap/25.4

In this embodiment, the amount of electrical power supplied to the endeffector 126 is controlled by varying the frequency of the switchingsignals used to switch the FET's 243. This works because the resonantcircuit 250 acts as a frequency dependent (loss less) attenuator. Thecloser the drive signal is to the resonant frequency of the resonantcircuit 250, the less the drive signal is attenuated. Similarly, as thefrequency of the drive signal is moved away from the resonant frequencyof the circuit 250, the more the drive signal is attenuated and so thepower supplied to the load reduces. In this embodiment, the frequency ofthe switching signals generated by the FET gate drive circuitry 245 iscontrolled by a controller 281 based on a desired power to be deliveredto the load 259 and measurements of the load voltage (V_(L)) and of theload current (I_(L)) obtained by conventional voltage sensing circuitry283 and current sensing circuitry 285. The way that the controller 281operates will be described in more detail below.

In one embodiment, the voltage sensing circuitry 283 and the currentsensing circuitry 285 may be implemented with high bandwidth, high speedrail-to-rail amplifiers (e.g., LMH6643 by National Semiconductor). Suchamplifiers, however, consume a relatively high current when they areoperational. Accordingly, a power save circuit may be provided to reducethe supply voltage of the amplifiers when they are not being used in thevoltage sensing circuitry 283 and the current sensing circuitry 285. Inone-embodiment, a step-down regulator (e.g., LT1502 by LinearTechnologies) may be employed by the power save circuit to reduce thesupply voltage of the rail-to-rail amplifiers and thus extend the lifeof the battery 237.

FIG. 8C shows the main components of the controller 281, according toone embodiment. In the embodiment illustrated in FIG. 8C, the controller281 is a microprocessor based controller and so most of the componentsillustrated in FIG. 8c are software based components. Nevertheless, ahardware based controller 281 may be used instead. As shown, thecontroller 281 includes synchronous I,Q sampling circuitry 291 thatreceives the sensed voltage and current signals from the sensingcircuitry 283 and 285 and obtains corresponding samples which are passedto a power, V_(rms) and I_(rms) calculation module 293. The calculationmodule 293 uses the received samples to calculate the RMS voltage andRMS current applied to the load 259 (FIG. 8B; end effector 126 andtissue/vessel gripped thereby) and from them the power that is presentlybeing supplied to the load 259. The determined values are then passed toa frequency control module 295 and a medical device control module 297.The medical device control module 297 uses the values to determine thepresent impedance of the load 259 and based on this determined impedanceand a pre-defined algorithm, determines what set point power (P_(set))should be applied to the frequency control module 295. The medicaldevice control module 297 is in turn controlled by signals received froma user input module 299 that receives inputs from the user (for examplepressing buttons 228 or activating the control levers 221 on the handle212) and also controls output devices (lights, a display, speaker or thelike) on the handle 212 via a user output module 261.

The frequency control module 295 uses the values obtained from thecalculation module 293 and the power set point (P_(set)) obtained fromthe medical device control module 297 and predefined system limits (tobe explained below), to determine whether or not to increase or decreasethe applied frequency. The result of this decision is then passed to asquare wave generation module 263 which, in this embodiment, incrementsor decrements the frequency of a square wave signal that it generates by1 kHz, depending on the received decision. As those skilled in the artwill appreciate, in an alternative embodiment, the frequency controlmodule 295 may determine not only whether to increase or decrease thefrequency, but also the amount of frequency change required. In thiscase, the square wave generation module 263 would generate thecorresponding square wave signal with the desired frequency shift. Inthis embodiment, the square wave signal generated by the square wavegeneration module 263 is output to the FET gate drive circuitry 245,which amplifies the signal and then applies it to the FET 243-1. The FETgate drive circuitry 245 also inverts the signal applied to the FET243-1 and applies the inverted signal to the FET 243-2.

The electrosurgical instrument 210 may comprise additional features asdiscussed with respect to the electrosurgical system 100 illustrated inFIGS. 1-6. Those skilled in the art will recognize that electrosurgicalinstrument 210 may include a rotation knob 148, an elongated shaft 114,and an end effector 126. These elements function in a substantiallysimilar manner to that discussed above with respect to theelectrosurgical system 100 illustrated in FIGS. 1-6. In one exampleembodiment, the cordless electrosurgical instrument 210 may includevisual indicators 235. The visual indicators 235 may provide a visualindication signal to an operator. In one example embodiment, the visualindication signal may alert an operator that the device is on, or thatthe device is applying energy to the end effector. Those skilled in theart will recognize that the visual indicators 235 may be configured toprovide information on multiple states of the device.

According to various embodiments, the electrosurgical systems herein maybe programmed to limit the rise of tissue impedance during the initialand middle parts of the coagulation cycle by limiting the poweravailable in the higher impedances. As the natural tendency of tissuebeing treated in vessel sealing electrosurgical systems is to exhibit adramatic rise in impedance at a certain point in the process, this mayallow the impedance to rise more slowly than it would if a full rangeload curve were applied to the tissue. When tissue is grasped by an endeffector with bipolar electrodes and a full range load curve is applied,there is sometimes a short time when the tissue impedance makes adrastic change from the lower impedance to the higher impedances. Thisis when the tissue and especially the fluids associated with that tissueare going through phase change. If the power is limited at theimpedances that are expected to be encountered during this transitionthen the rate of rise in the impedance will be limited. This desiredeffect may have benefits in producing desired tissue effects and canreduce the power delivered to the tissue as the water begins to boil andreduce the popping that is occasionally seen in electrosurgicalinstruments.

The electrosurgical systems 100, 200 (e.g., the generators 120, 220) maybe programmed to provide power to a tissue bite between jaws 164 a, 164b according to any suitable method or algorithm. For example, in someembodiments, the generator 120, 220 may provide an electrosurgical drivesignal according to one or more power curves. A power curve may define arelationship between power delivered to the tissue and the impedance ofthe tissue. For example as the impedance of the tissue changes (e.g.,increases) during coagulation, the power provided by the generator 120,220 may also change (e.g., decrease) according to the applied powercurve.

Different power curves may be particularly suited, or ill-suited, todifferent types and/or sizes of tissue bites. Aggressive power curves(e.g., power curves calling for high power levels) may be suited forlarge tissue bites. When applied to smaller tissue bites, such as smallvessels, more aggressive power curves may lead to exterior searing orother deleterious effects. Exterior searing may reduce thecoagulation/weld quality at the exterior and can also prevent completecoagulation of interior portions of the tissue. Similarly, lessaggressive power curves may fail to achieve hemostasis when applied tolarger tissue bites (e.g., larger bundles).

FIG. 9 shows one embodiment of a chart 1300 showing example power curves1306, 1308, 1310. The chart 1300 comprises an impedance axis 1302showing increasing potential tissue impedances from left to right. Apower axis 1304 shows increasing power from down to up. Each of thepower curves 1306, 1308, 1310 may define a set of power levels, on thepower axis 1304, corresponding to a plurality of potential sensed tissueimpedances, in the impedance axis 1302. In general, power curves maytake different shapes, and this is illustrated in FIG. 9. Power curve1306 is shown with a step-wise shape, while power curves 1308, 1310 areshown with curved shapes. It will be appreciated that power curvesutilized by various embodiments may take any usable continuous ornon-continuous shape. The rate of power delivery or aggressiveness of apower curve may be indicated by its position on the chart 1300. Forexample, power curves that deliver higher power for a given tissueimpedance may be considered more aggressive. Accordingly, between twopower curves, the curve positioned highest on the power axis 1304 may bethe more aggressive. It will be appreciated that some power curves mayoverlap.

The aggressiveness of two power curves may be compared according to anysuitable method. For example, a first power curve may be considered moreaggressive than a second power curve over a given range of potentialtissue impedances if the first power curve has a higher delivered powercorresponding to at least half of the range of potential tissueimpedances. Also, for example, a first power curve may be consideredmore aggressive than a second power curve over a given range ofpotential tissue impedances if the area under the first curve over therange is larger than the area under the second curve over the range.Equivalently, when power curves are expressed discretely, a first powercurve may be considered more aggressive than a second power curve over agiven set of potential tissue impedances if the sum of the power valuesfor the first power curve over the set of potential tissue impedances isgreater than the sum of the power values for the second power curve overthe set of potential tissue impedances.

As described herein, some embodiments of the instrument 110 comprise apositive temperature coefficient (PTC) material positioned between oneor both of the electrodes of the jaw members 164 a, 164 b. The PTCmaterial may have an impedance profile that remains relatively low andrelatively constant until it reaches a threshold or trigger temperature,at which point the impedance of the PTC material may increase. In use,the PTC material may be placed in contact with the tissue while power isapplied. The trigger temperature of the PTC material may be selectedsuch that it corresponds to a tissue temperature indicating thecompletion of welding or coagulation. Accordingly, as a welding orcoagulation process is completed, the temperature of the PTC materialmay increase, causing a corresponding increase in the impedance of thePTC material. This additional series impedance, in series with thetissue, may cause a decrease in power actually provided to the tissue.

It will be appreciated that during the coagulation or welding process,tissue impedance may generally increase. In some embodiments, tissueimpedance may display a sudden impedance increase indicating successfulcoagulation. The increase may be due to physiological changes in thetissue, a PTC material reaching its trigger threshold, etc. The amountof energy that may be required to bring about the sudden impedanceincrease may be related to the thermal mass of the tissue being actedupon. The thermal mass of any given tissue bite, in turn, may be relatedto the type and amount of tissue in the bite.

Various embodiments may utilize this sudden increase in tissue impedanceto select an appropriate power curve for a given tissue bite. Forexample, the generator 120, 220 may select and apply successively moreaggressive power curves until the tissue impedance reaches an impedancethreshold indicating that the sudden increase has occurred. For example,reaching the impedance threshold may indicate that coagulation isprogressing appropriately with the currently applied power curve. Theimpedance threshold may be a tissue impedance value, a rate of change oftissue impedance, and/or a combination of impedance and rate of change.For example, the impedance threshold may be met when a certain impedancevalue and/or rate of change are observed. According to variousembodiments, different power curves may have different impedancethresholds, as described herein.

FIG. 10 shows one embodiment of a process flow 1330 for applying one ormore power curves to a tissue bite. Any suitable number of power curvesmay be used. The power curves may be successively applied in order ofaggressiveness until one of the power curves drives the tissue to theimpedance threshold. At 1332, the generator 120, 220 may apply a firstpower curve. According to various embodiments, the first power curve maybe selected to deliver power at a relatively low rate. For example, thefirst power curve may be selected to avoid tissue searing with thesmallest and most vulnerable expected tissue bites.

The first power curve may be applied to the tissue in any suitablemanner. For example, the generator 120, 220 may generate a drive signalimplementing the first power curve. The power curve may be implementedby modulating the power of the drive signal. The power of the drivesignal may be modulated in any suitable manner. For example, the voltageand/or current of the signal may be modulated. Also, in variousembodiments, the drive signal may be pulsed. For example, the generator120, 220 may modulate the average power by changing the frequency, pulsewidth, duty cycle, etc. of the drive signal. The drive signal may beprovided to the electrodes of the first and second jaw members 164 a,164 b.

While applying the first power curve, the generator 120, 220 may monitorthe total energy provided to the tissue. The impedance of the tissue maybe compared to the impedance threshold at one or more energy thresholds.There may be any suitable number of energy thresholds, which may beselected according to any suitable methodology. For example, the energythresholds may be selected to correspond to known points where differenttissue types achieve the impedance threshold. At 1334, the generator120, 220 may determine whether the total energy delivered to the tissuehas met or exceeded a first energy threshold. If the total energy hasnot yet reached the first energy threshold, the generator 120, 220 maycontinue to apply the first power curve at 1332.

If the total energy has reached the first energy threshold, thegenerator 120, 220 may determine whether the impedance threshold hasbeen reached (1336). As described above, the impedance threshold may bea predetermined rate of impedance change (e.g., increase) apredetermined impedance, or combination of the two. If the impedancethreshold is reached, the generator 120, 220 may continue to apply thefirst power curve at 1332. For example, reaching the impedance thresholdin the first power curve may indicate that the aggressiveness of thefirst power curve is sufficient to bring about suitable coagulation orwelding.

In the event that the impedance threshold is not reached at 1336, thegenerator 120, 220 may increment to the next most aggressive power curveat 1338 and apply the power curve as the current power curve at 1332. Insome embodiments, incrementing to the next most aggressive power curvemay comprise applying a multiplier to a less aggressive power curve suchas, for example, the previously implemented power curve. When the nextenergy threshold is reached at 1334, the generator 120, 220 again maydetermine whether the impedance threshold is reached at 1336. If it isnot reached, the generator 120, 220 may again increment to the next mostaggressive power curve at 1338 and deliver that power curve at 1332.

The process flow 1330 may continue until terminated. For example, theprocess flow 1330 may be terminated when the impedance threshold isreached at 1336. Upon reaching the impedance threshold, the generator120, 220 may apply the then-current power curve until coagulation orwelding is complete. Also, for example, the process flow 1330 mayterminate upon the exhaustion of all available power curves. Anysuitable number of power curves may be used. If the most aggressivepower curve fails to drive the tissue to the impedance threshold, thegenerator 120, 220 may continue to apply the most aggressive power curveuntil the process is otherwise terminated (e.g., by a clinician or uponreaching a final energy threshold).

According to various embodiments, the process flow 1330 may continueuntil the occurrence of a termination threshold. The terminationthreshold may indicate that coagulation and/or welding is complete. Forexample, the termination threshold may be based on one or more of tissueimpedance, tissue temperature, tissue capacitance, tissue inductance,elapsed time, etc. Upon termination, the surgical system 100, 200 maygenerate an audible tone indicating termination. These may be a singletermination threshold or, in various embodiments, different power curvesmay have different termination thresholds. According to variousembodiments, different power curves may utilize different impedancethresholds. For example, the process flow 1330 may transition from afirst to a second power curve if the first power curve has failed todrive the tissue to a first tissue impedance threshold and may,subsequently, shift from the second to a third power curve if the secondpower curve has failed to drive the tissue to a second impedancethreshold. In some embodiments, rather than proceeding between powercurves in order, the generator 120, 220 may skip one or more powercurves. For example, if the impedance of the tissue at the end of apower curve exceeds a skip threshold, then generator 120, 220, insteadof proceeding to the next power curve, may skip to a more aggressivepower curve (e.g., a power curve that provides more energy for a giventissue impedance).

In some embodiments utilizing a pulsed drive signal, the generator 120,220 may apply one or more composite load curves to the drive signal, andultimately to the tissue. Composite load curves, like other power curvesdescribed herein, may define a level of power to be delivered to thetissue as a function of a measured tissue property or properties.Composite load curves may, additionally, define pulse characteristics,such as pulse width, in terms of the measured tissue properties (e.g.,impedance, applied current, applied voltage, temperature, reflectivity,force applied to the tissue, etc.).

FIG. 11 shows one embodiment of a process flow or algorithm 1452, asimplemented by the generator 120, 220. The algorithm 1452 may beactivated at 1476. It will be appreciated that the algorithm 1452 may beactivated in any suitable manner. For example, the algorithm 1452 may beactivated by a clinician upon actuation of the surgical device 104, 106(e.g., by pulling or otherwise actuating the jaw closure trigger 121,button 128, etc.).

According to various embodiments, the algorithm 1452 may comprise aplurality of modes 1478, 1480, 1482, 1484. Each mode may represent adifferent stage of the cutting and coagulation of a tissue bite. Forexample, in the first mode 1478, the generator 120, 220 may perform ananalysis of initial tissue conditions (e.g., impedance, etc.). In thesecond mode 1480, the generator 120, 220 may apply energy to the tissuein order to prepare the tissue for cutting. In the third or cut mode1482, the generator 120, 220 may continue to apply energy while theinstrument 110 cuts the tissue, for example, by advancing the cuttingelement 171. In the fourth or completion mode 1484, the generator 120,220 may apply energy post-cut to complete coagulation.

Referring now to the first mode 1478, the generator 120, 220 may measureany suitable tissue condition or conditions including, for example,current, voltage, temperature, reflectivity, force applied to thetissue, etc. In various embodiments, an initial impedance of the tissuemay be measured according to any suitable manner. For example, thegenerator 120, 220 may modulate the drive signal to provide a knownvoltage or currency to the tissue. Impedance may be derived from theknown voltage and the measured current or vice versa. It will beappreciated that tissue impedance may alternately or additionally bemeasured in any other suitable manner. According to the algorithm 1452,the generator 120, 220 may proceed from the first mode 1478 to thesecond mode 1480. In various embodiments, the clinician may end thealgorithm 1452 in the first mode 1478, for example, by deactivating thegenerator 120, 220 and/or the surgical device 110. If the clinicianterminates the algorithm 1542, RF delivery may also be terminated at1486.

In the second mode 1480, the generator 120, 220 may begin to applyenergy to the tissue via the drive signal to prepare the tissue forcutting. In embodiments utilizing a pulsed drive signal, applying energyaccording to the second mode 1480 may comprise modulating pulses ontothe drive signal according to load curves including, for example,composite load curves. In various embodiments, load curves may besuccessively applied in the second mode in order of aggressiveness(e.g., to accommodate various types of tissue-volume clamped in theinstrument jaws). The second mode 1480 may be terminated upon theoccurrence of various events. For example, if the total RF applicationtime has exceeded a timeout time, then the generator 120, 220 may endthe tissue operation by terminating RF delivery at 1486. Also, variousevents may cause the generator 120, 220 to transition from the secondmode 1480 to the third mode 1482. For example, the generator 120, 220may transition to the third mode 1482 when the tissue impedance (Z)exceeds a threshold tissue impedance (Z_(term)) and RF energy has beendelivered for at least more than a minimum time (T_(start)). Thethreshold tissue impedance may be a fixed impedance or may be a functionof other specific parameters or variables sensed by the instrument orgenerator. Examples of other parameters that may determine the thresholdtissue impedance include minimum impedance, compressive forces ontissue, etc. Additionally, the threshold impedance may be set as afunction of the rate of change of the tissue impedance by observing therate of change of the tissue impedance and calculating a correspondingimpedance threshold value.

According to various embodiments, if the final load curve 1462 iscompleted in the second mode 1480 before completion of the second mode1480, then the final power curve 1462 may be continuously applied, forexample, until the tissue impedance threshold is met, the maximum secondmode time is reached and/or the timeout time is reached. Also, it willbe appreciated that, with some tissue cuts, the second mode 1480 may becompleted before all available consolidated load curves 1456, 1458,1460, 1462 are executed.

At the third mode 1482, the generator 120, 220 may continue to modulatepulses onto the drive signal. Generally, third mode pulses may bemodulated onto the drive signal according to any suitable mannerincluding, for example, that described above with reference to theprocess flow 1488. The power and pulse characteristics of the third modepulses may be determined according to any suitable method and, invarious embodiments, may be determined based on the composite load curvethat was being executed at the completion of the second mode 1480 (thecurrent load curve). According to various embodiments, the current loadcurve may be utilized to determine the pulse power of third mode pulses,while the pulse characteristics (e.g., pulse width, ramp time, falltime, off time, etc.) may be constant regardless of composite loadcurve. In some embodiments, the third mode 1482 may utilize athird-mode-specific composite load curve that may be one of the loadcurves 1456, 1458, 1460, 1462 utilized in the second mode 1480, or maybe a different composite load curve (not shown).

The generator 120, 220 may continue to execute the third mode 1482 untilreceiving an indication that the tissue cut is complete. In embodimentsutilizing surgical implements having a knife or other cutting element,such as 171, the indication may be received when the cutting element 171reaches its distal-most position. This may trip a knife limit sensor(not shown) indicating that the cutting element 171 has reached the endof its throw. Upon receiving the indication that the tissue cut iscomplete, the generator 120, 220 may continue to the fourth mode 1484.It will also be appreciated that, in some embodiments, the generator120, 220 may transition from the third mode 1482 directly to RFtermination at 1486, for example, if the timeout time has been reached.

In the fourth mode 1484, the generator 120, 220 may provide an energyprofile designed to complete coagulation of the now-cut tissue. Forexample, according to various embodiments, the generator 120, 220 mayprovide a predetermined number of pulses. The pulses may be provided ina manner similar to that described above with respect to the processflow 1488. The power and pulse characteristics of the pulses may bedetermined according to any suitable manner. For example, power andpulse characteristics of the fourth mode pulses may be determined basedon the current composite load curve, the third-mode-specific load curve,or a fourth-mode-specific composite load curve. In some embodiments,power may be determined based on the current composite load curve, whilepulse characteristics may be fourth mode-specific. Also, according tovarious embodiments, the power and pulse characteristics of fourth modepulses may be determined independent of the current composite loadcurve. In some embodiments, the electrosurgical system 100, 200 may beconfigured to generate an audible tone upon termination of RF deliveryat 1486.

According to various embodiments, it is desirable to manage the rise oftissue impedance during treatment of a tissue bite (a treatment cycle,or cycle). During coagulation, tissue impedance serves as an abstractionof the condition of the tissue. Changes in tissue impedance correlate tochanges in the tissue itself that are indicators of the degree ofcompletion of the coagulation. Accordingly, many drive signal algorithmslook for a threshold tissue impedance to determine when during atreatment cycle coagulation is complete. The tissue impedance during atreatment cycle also provides indications of the properties of theresulting coagulation or seal. For example, the quality of coagulationcan be increased by managing the rate of impedance increase during atreatment cycle.

According to various embodiments, the electrosurgical system 100, 200(e.g., the generator 120, 220 thereof) is programmed to manage the rateof impedance increase during tissue treatment. In some embodiments, thegenerator 120, 220 is programmed to implement multiple successive drivesignal modes or modes. Within each mode, the generator 120, 220 maymodulate the drive signal to reduce the amount of power provided to thetissue when the tissue impedance exceeds one or more threshold values.For example, if the tissue impedance during application of a modeexceeds a threshold impedance value for that mode, the generator 120,220 may reduce the power made available to tissue via the drive signal.This may be implemented by direct limits on the power of the drivesignal or indirectly by limiting the voltage level of the drive signal.In various embodiments some or all of the modes may have multipleimpedance thresholds. For example, the generator 120, 220 may reduce thepower of the drive signal further as successively higher impedancethresholds are reached. The threshold impedances, as well as the powerprovided after the threshold impedances, may generally increase as thesystem 100, 200 progresses from mode to mode.

The duration of each mode may be determined in any suitable manner. Forexample, in some embodiments, some or all of the modes may be appliedfor a predetermined amount of time or application period. Also, invarious embodiments, some or all of the modes may be applied for apredetermined amount of time after a threshold tissue impedance for themode is met. It will be appreciated that specific values, including thenumber of modes, the tissue impedance threshold or thresholds for eachmode, application period of each mode, etc., may vary from applicationto application. For example, these values may vary based on the size andshape of the electrodes being used, the type of tissue being treated,etc.

According to various embodiments, three modes may be utilized. FIG. 12shows one embodiment of a process flow 1700 for managing tissueimpedance during a treatment cycle utilizing three modes. The treatmentcycle is initiated with a first mode 1702. FIG. 12a is a chart showingpower and impedance characteristics of one embodiment of a drive signalthat may be provided by the generator 120, 220 during the first mode1702. In FIG. 12, impedance is indicated in axis 1201 and power isindicated on axis 1203. During the first mode 1702, the generator 120,220 may be configured to provide a first power threshold 1206 to thetissue while the tissue impedance is below a threshold impedance 1208for the mode 1702. If the impedance of the tissue exceeds the thresholdimpedance 1208 for the mode 1702, the generator 120, 220 may limit theprovided power to a second power threshold 1210. In various embodiments,the second power threshold 1210 may be less than the maximum power thatthe generator 120, 220 is configured to deliver to the tissue. In thisway, the first mode 1702 may prepare the tissue for greater powerapplication in later modes. The application period for the first mode1702 may be any suitable value including, for example, one second. Itwill be appreciated that the drive signal may be pulsed duringapplication of the first mode 1702. For example, the mode 1702 may beapplied as a single pulse lasting the duration of the application timeperiod for the mode 1702, or in multiple shorter pulses. In embodimentsutilizing multiple pulses in the mode 1702, each pulse may conform toimpedance-determined limits for drive signal power, as described.

FIG. 12b is a chart showing power and impedance characteristics of oneembodiment of a drive signal that may be provided by the generator 120,220 during the second mode 1704. In the second mode 1704, the generator120, 220 provides a relatively high level of power at the lowest tissueimpedances expected to be encountered. For example, in some embodiments,the full power available from the generator (1212 in FIG. 12b ) may beprovided at tissue impedances below the threshold impedance 1216 for thesecond mode 1704. Above the threshold impedance 1216, the power may bereduced below a second power threshold 1214 so as to limit the rate ofimpedance increase. In some embodiments, the second power threshold 1214is greater than the second power threshold 1210 of the first mode 1702.Also, it will be appreciated that the impedance threshold 1208 of thefirst mode 1702 and the impedance threshold 1216 of the second mode 1704may be equal or may take different values depending on theimplementation. The application period of the second mode may be longerthan that of the first mode so as to allow the provided energy to act onthe tissue. For example, in some embodiments, the application period ofthe second period is between four and five seconds. It will beappreciated that the drive signal may also be provided as a single pulselasting the duration of the application period and/or as multiplepulses. Again, when multiple pulses are used, each pulse may conform tothe impedance-determined limits for drive signal power.

FIG. 12c is a chart showing power and impedance characteristics of oneembodiment of a drive signal that may be provided by the generator 120,220 during the third mode 1706. In the third mode 1706, the generator120, 220 provides a drive signal with a drive signal power limit 1218configured to drive the tissue impedance to a final value indicatingcompletion of the tissue cycle. For example, if tissue impedance remainsbelow a threshold value 1220 for the mode 1706, the generator 120, 220may provide a relatively high level of power 1218. In some embodiments,the drive signal power limit 1218 may be the maximum power availablefrom the generator 120, 220. Above the threshold impedance, thegenerator 120, 220 may provide a lower level of power. Theabove-threshold power provided in the third mode 1706, for example, maybe higher than the above-threshold power provided in the second mode1704. This may allow the tissue impedance to rise faster in the thirdmode 1706 towards a final target impedance. In some embodiments, theabove-threshold power provided in the third mode 1706 may be up to thelimit 1218. In some embodiments, the third mode 1706 may comprisemultiple sub-modes that successively raise the above-threshold power soas to drive the tissue to the final target impedance indicatingcompletion of the tissue cycle. Each sub-mode may be applied as one ormore pulses. The application period of the sub-modes may be determinedin any suitable manner. For example, the application period of the thirdmode may be divided into multiple sub-periods, with each sub-periodcorresponding to a sub-mode. Also, in some embodiments, each sub-modemay comprise a pulse of a predetermined time that is applied as part ofthe drive signal. In some embodiments, the third mode (e.g., the finalsub-mode thereof) may be applied until the tissue impedance increases toa level indicating completion of coagulation or the end of the tissuecycle (e.g., a final termination impedance). In some embodiments, thefinal termination impedance may be 300Ω.

FIG. 13 is a chart 2000 showing voltage and tissue impedance thresholdsthat may be applied during a first mode, such as the first mode 1702,according to one embodiment. In the chart 2000, load or tissue impedanceis expressed on the horizontal axis while current 2006, voltage 2004 andpower 2002 are expressed on the vertical axis. Values for current 2006,voltage 2004 and power 2002 shown in FIG. 13 represent the maximumvalues for these quantities permitted during the first mode 1702 as afunction of tissue impedance. In the example shown in FIG. 13, twoimpedance thresholds are utilized. When the tissue impedance is below afirst threshold (e.g., 75Ω), a maximum voltage of the drive signal islimited to 80 Volts. This, practically, limits the power to 135 Watts,as illustrated. Between the first threshold and a second threshold(e.g., 100Ω), the maximum voltage of the drive signal ramps between 50Volts and 60 Volts, which limits the drive signal power to 45 Watts.Above the second threshold, drive signal voltage is limited to 60 Volts.As illustrated, this limits the power 2002 of the drive signal to 45Watts or less, with power decreasing as tissue impedance increases. Theapplication period of the first mode as described in FIG. 13 may be, forexample one second. Because the values shown in FIG. 13 are thresholds,it will be appreciated that not every application of the first mode inthe manner shown in FIG. 13 will result in the full range of tissueimpedances shown. Also, as described above, the first mode of FIG. 13may be implemented as a single pulse or as multiple pulses during theapplication period.

FIG. 14 is a chart 2010 showing voltage and tissue impedance thresholdsthat may be applied during a second mode, such as the second mode 1704,according to one embodiment. The example of FIG. 14, like the example ofFIG. 13, shows two impedance thresholds within the second mode. Whentissue impedance is less than the first threshold (e.g., 50Ω), the drivesignal voltage may be limited to 100 Volts, resulting in a drive signalpower of 200 Watts or less. In some embodiments, this may represent themaximum power that the generator 120, 220 is configured to deliver totissue. Between the first impedance threshold and the second impedancethreshold (e.g., 100Ω in FIG. 14), the drive signal voltage may belimited to a second level (e.g., 100 Volts in FIG. 14). This may causethe drive signal power 2002 to be reduced, as shown. At above the secondimpedance threshold, the generator 120, 220 may limit the voltage of thedrive signal to a second threshold level (e.g., 75 Volts). This mayfurther limit the power 2002 to less than 50 Watts, as illustrated. Insome embodiments, the application period of the second mode illustratedin FIG. 14 is between four and five seconds. Again, because the valuesshown in FIG. 14 are thresholds, it will be appreciated that not everyapplication of the second mode, as illustrated, will result in the fullrange of tissue impedances shown. Also, it will be appreciated that thedrive signal may be pulsed during application of the second mode. Forexample, the second mode may be applied as a single pulse lasting theduration of the application time period, or in multiple shorter pulses.In embodiments utilizing multiple pulses, each pulse may conform to thethresholds for drive signal power 2002 and voltage 2004, for example, asillustrated in FIG. 14.

As described herein, the third mode, or termination mode, may comprise aplurality of sub-modes comprising different impedance thresholds andcorresponding power or voltage limits. FIG. 15 is a chart 2012 showingvoltage and impedance thresholds for a first sub-mode of the third mode,such as the third mode 1706. It will be appreciated that the firstsub-mode may be applied as a single pulse or as multiple pulses. Theexample first sub-mode shown in FIG. 15 utilizes a single impedancethreshold at 120Ω. When the tissue impedance is below 120Ω, thegenerator 120, 220 may provide a relatively high level of power. In FIG.15, this is indicated by a voltage limit of 100V, corresponding to adrive signal power limit of 200 Watts, which may represent the maximumpower of the generator 120, 220. In some embodiments, if the tissue isstill below the threshold value of the first sub-mode, it may requirehigh power to complete coagulation by the end of the termination mode.Beyond the impedance threshold, the voltage of the drive signal islimited to 70 Volts, resulting in a drive signal power 2002 of less than50 Watts, as shown. The first sub-mode of FIG. 15 may be applied as oneor more pulses and may have an application period, for example of onesecond.

Subsequent sub-modes of the third or termination mode may increase thepower of the post-threshold drive signal. For example, FIG. 16 is achart 2014 showing voltage and impedance thresholds for a secondsub-mode of a third mode, such as the third mode 1706. In FIG. 16, thepost-threshold drive signal voltage 2004 is limited to 85 Volts,allowing a higher post-threshold drive signal power 2002. The secondsub-mode of FIG. 16 may be applied as one or more pulses and may have anapplication period of one second. Finally, FIG. 17 is a chart 2016showing voltage and impedance thresholds for a third sub-mode of a thirdmode, such as the third mode 1706. In the third sub-mode, the drivesignal voltage 2004 is limited to 100 Volts throughout the mode,allowing increased drive signal power 2002 relative to the first andsecond sub-modes illustrated in FIGS. 15 and 16. In some embodiments,the third sub-mode may entail the generator 120, 220 providing itsmaximum available power. The third sub-mode may be applied for asuitable application period and/or may be applied until the tissuereaches a final termination impedance indicating completion ofcoagulation and, therefore, completion of the tissue cycle.

FIG. 18 is a chart 2200 showing tissue impedance during one tissue cycleaccording to the process flow 1700 and utilizing the threshold valuesillustrated in FIGS. 13-17. In the chart 2200, a first mode 2202,corresponding to FIG. 13, extends for an application period of 1.4seconds, or 1,400 milliseconds. As illustrated, tissue impedance remainslow (e.g., below 25Ω) for much of the first mode 2202 and begins to rampup at the end. Instead of allowing the impedance to continue its highrate of increase, the generator 120, 220 begins a second mode 2204 atabout 1.4 seconds and continues it for an application period of aboutfour seconds to 5.4 seconds, or 5,400 milliseconds. As illustrated, thetissue impedance exceeds the first and second threshold impedances ofthe second mode 2204 at 2210, causing the generator 120, 220 to apply aconstant voltage drive signal in at 2212. The result is a gently slopingincrease in tissue impedance, as illustrated by 2212. Upon theexpiration of the second mode 2204, the generator 120, 220 applies athird mode 2206 comprising three sub-modes 2214, 2216, 2218. In thesemodes, as illustrated, tissue impedance increases at a greater rate thanin the second mode 2204 until a termination impedance (e.g., 500Ω) isreached.

In the embodiments described above, the electrosurgical drive signal (RFdelivery) is terminated at the conclusion of the algorithm, typically atthe conclusion of a tissue bite. To treat subsequent tissue bite, theclinician closes the jaws 164 a, 164 b over the subsequent tissue biteand then re-initiates the generator 120, 220 to provide the drivesignal, for example, according to a delivery algorithm such as thosedescribed herein above with respect to FIGS. 9-18. In some embodiments,however, it is desirable for the surgical system 100, 200 to bemaintained in an expert or repeat mode where provision of the drivesignal is initiated for another tissue cycle automatically upon graspinga subsequent tissue bite and without the need for the clinician tomanually toggle a button such as 128, 228. In an expert or speed mode ofthis type, the number of steps that a clinician must make to treatsuccessive tissue bites is reduced as the clinician simply cycles thejaw closure control.

FIG. 19 shows one embodiment of a process flow 900 for applying a speedor expert mode in the context of a surgical system such as 100 or 200.At 902, the surgical system 100, 200 receives input from a clinicianindicating the expert or repeat mode. The input of 902 may be receivedin any suitable manner. For example, in some embodiments, the clinicianmay indicate the expert or repeat mode by selecting the button 128, 228twice as a “double-click.” In some embodiments, the clinician invokesthe expert or repeat mode by continuing to depress the button 128, 228after the power delivery cycle or tissue bit algorithm has beencompleted. In some embodiments, the surgical systems 100, 200 maycomprise an additional soft or hard input mechanism for indicating therepeat mode. For example, in some embodiments, the indication may bereceived via an input device 135 of the generator 120. At 904, thesurgical system 100, 200 may apply a tissue bite algorithm. Any suitabletissue bite algorithm or power delivery algorithm may be used, includingthe algorithms 1330, 1452 described herein above utilizing power curves,as described. At the termination of the algorithm, the surgical systems100, 200 may not terminate the drive signal, as described with respectto algorithms 1330, 1452. Instead, the surgical systems 100, 200 mayenter a hold state 906. During the hold state, the generator 120, 220may await an indication of the beginning of a new tissue bite. The drivesignal may be terminated or maintained at a low level during the holdstate. For example, in some embodiments, the drive signal may bemaintained at a low level to facilitate the detection of a new tissuebite. For example, a sub-therapeutic output, such as a pulsedsub-therapeutic output, may be provided during the hold state 906. Forexample, the sub-therapeutic signal may facilitate the detection of anew tissue bite by allowing the system to continue to monitor the stateof the end effector, as described herein below. In some embodiments, anend-of-cycle tone or other sound may be generated during the hold state.For example, the end-of-cycle tone or other sound may continue to loopwhile the clinician continues to hold the button 128, 228 closed. Thecontinuation of audible feedback may serve as a reminder to theclinician that the system is still monitoring and awaiting a new tissuebite.

At 908, the electrosurgical system 100, 200 may determine whether a newtissue bite has begun. This may be determined in any suitable manner.For example, when the electrosurgical system 100, 200 maintains asub-therapeutic drive signal during the hold state 906, the beginning ofa new tissue bite may be determined by a reduction in impedance betweenthe electrodes of the jaw members 164 a, 164 b. For example, when thejaw members 164 a, 164 b are in an open position without tissue betweenthem, it may create the equivalent of an open circuit or near-opencircuit, resulting in a large impedance. When the electrodes thencontact a subsequent tissue bite, the impedance sensed by thesub-therapeutic signal is reduced. In some embodiments, the surgicalsystem 100, 200 may detect an increase in impedance (indicating anopening of the jaws 164 a, 164 b) followed by a decrease in impedance(indicating closure of the jaws 164 a, 164 b on a new tissue bite).Impedance changes may be measured relative to any suitable referenceincluding, for example, an impedance measured at the completion of theprevious application or cycle of the tissue bite algorithm at 904. Anyother suitable indicator of the beginning of a new tissue bite may beused. For example, in some embodiments, a new tissue bite may beindicated when the jaw-closure trigger 121, 221, is opened and thenclosed again.

When the beginning of a new tissue bite is detected at 908, the surgicalsystem 100, 200 may apply another cycle of the tissue bite algorithm at910. Upon completion of the cycle at 910, the electrosurgical system100, 200 may again enter the hold state 906, as described herein. On theother hand, if no new tissue bite is detected at 908, the process 900may terminate at 909. Termination of the output may include terminationof the therapeutic as well as sub-therapeutic outputs, if any. Theabsence of a new tissue bite may be detected in any suitable manner. Forexample, if no new tissue bite is detected within a predeterminedthreshold time period after entering the hold state 906, termination 909may result. In some embodiments, the threshold time period may beselected to be an integer multiple of the duration of the end-of-cycletone. Also, for example, the handle 112, 212 may comprise anaccelerometer or other suitable tilt sensor for sensing a position ofthe handle 112, 212. If the handle 112, 212 remains stationary for apredetermined amount of time, or is placed on a resting orientation, thesurgical system 100, 200 may determine that no new tissue bite isdetected and terminate at 909.

It will be appreciated that the process flow 900 may be implemented withdifferent requirements for the actuation button 128, 228. For example,in some embodiments, the process flow 900 may terminate at 909 from anyof the other actions when the clinician releases the actuation button128, 228. In this way, the clinician may be provided with a way ofceasing the provision of energy. In other embodiments, it may not benecessary for the clinician to maintain actuation of the button 128, 228in order to continue execution of the algorithm.

FIG. 20 shows an alternate embodiment of the process flow 1452′incorporating a repeat mode. The process flow 1452′ may be activated at1476′. Upon completion of the cycle at Mode IV (1484), theelectrosurgical system 100, 200 may enter a hold mode 1490, similar tothe hold mode 906. If the beginning of another tissue bite is detectedat the hold mode 1490, the system may progress again to Mode I (1478).In various embodiments, the timeout time of the generator 120, 220 maynot be reset upon re-entry of Mode I (1478). Other time-relatedthresholds related to the various modes 1478, 1480, 1482, 1484 may bereset. Also, tonal or other outputs from the systems 100, 200 may bereset so as to indicate to the clinician the mode in which the systems100, 200 are operating. FIG. 21 shows an alternate embodiment of theprocess flow 1700′ incorporating a repeat mode. Upon completion of thethird mode 1706, the electrosurgical system 100, 200 may enter a holdmode 2100, similar to the hold mode 906. If the beginning of anothertissue bite is detected at 2102, the system may progress again to thefirst mode (1702).

Although the embodiments described herein are electrosurgical systems,it will be appreciated that similar impedance management systems andmethods may be utilized with any suitable type of surgical systemincluding those that provide energy to tissue from an RF source, anultrasonic source, a direct current source (e.g., a direct currentsource powering a heating element), etc. Surgical systems that do notprovide current directly to the treated tissue may measure tissueimpedance utilizing one or more sensor electrodes. Sensor electrodes maybe positioned to contact the tissue. For example, in an ultrasonicsurgical system, sensor electrodes may be embedded in a pad opposite anultrasonic blade. The generator 120, 220 may be configured to provide asubtherapeutic electrical signal to the sensor electrodes. The resultingcurrent and voltage drop may indicate tissue impedance. Exampleembodiments for implementing sensor electrodes and providingsubtherapeutic signals are shown in U.S. Pat. No. 9,017,326, entitled“Impedance Monitoring Apparatus, System and Method for UltrasonicSurgical Instruments,” which is incorporated herein by reference in itsentirety.

It will be appreciated that the terms “proximal” and “distal” are usedthroughout the specification with reference to a clinician manipulatingone end of an instrument used to treat a patient. The term “proximal”refers to the portion of the instrument closest to the clinician and theterm “distal” refers to the portion located furthest from the clinician.It will further be appreciated that for conciseness and clarity, spatialterms such as “vertical,” “horizontal,” “up,” or “down” may be usedherein with respect to the illustrated embodiments. However, surgicalinstruments may be used in many orientations and positions, and theseterms are not intended to be limiting or absolute.

Various embodiments of surgical instruments and robotic surgical systemsare described herein. It will be understood by those skilled in the artthat the various embodiments described herein may be used with thedescribed surgical instruments and robotic surgical systems. Thedescriptions are provided for example only, and those skilled in the artwill understand that the disclosed embodiments are not limited to onlythe devices disclosed herein, but may be used with any compatiblesurgical instrument or robotic surgical system.

Reference throughout the specification to “various embodiments,” “someembodiments,” “one example embodiment,” or “an embodiment” means that aparticular feature, structure, or characteristic described in connectionwith the embodiment is included in at least one example embodiment.Thus, appearances of the phrases “in various embodiments,” “in someembodiments,” “in one example embodiment,” or “in an embodiment” inplaces throughout the specification are not necessarily all referring tothe same embodiment. Furthermore, the particular features, structures,or characteristics illustrated or described in connection with oneexample embodiment may be combined, in whole or in part, with features,structures, or characteristics of one or more other embodiments withoutlimitation.

While various embodiments herein have been illustrated by description ofseveral embodiments and while the illustrative embodiments have beendescribed in considerable detail, it is not the intention of theapplicant to restrict or in any way limit the scope of the appendedclaims to such detail. Additional advantages and modifications mayreadily appear to those skilled in the art. For example, it is generallyaccepted that endoscopic procedures are more common than laparoscopicprocedures. Accordingly, the present invention has been discussed interms of endoscopic procedures and apparatus. However, use herein ofterms such as “endoscopic”, should not be construed to limit the presentinvention to an instrument for use only in conjunction with anendoscopic tube (e.g., trocar). On the contrary, it is believed that thepresent invention may find use in any procedure where access is limitedto a small incision, including but not limited to laparoscopicprocedures, as well as open procedures.

It is to be understood that at least some of the figures anddescriptions herein have been simplified to illustrate elements that arerelevant for a clear understanding of the disclosure, while eliminating,for purposes of clarity, other elements. Those of ordinary skill in theart will recognize, however, that these and other elements may bedesirable. However, because such elements are well known in the art, andbecause they do not facilitate a better understanding of the disclosure,a discussion of such elements is not provided herein.

While several embodiments have been described, it should be apparent,however, that various modifications, alterations and adaptations tothose embodiments may occur to persons skilled in the art with theattainment of some or all of the advantages of the disclosure. Forexample, according to various embodiments, a single component may bereplaced by multiple components, and multiple components may be replacedby a single component, to perform a given function or functions. Thisapplication is therefore intended to cover all such modifications,alterations and adaptations without departing from the scope and spiritof the disclosure as defined by the appended claims.

Any patent, publication, or other disclosure material, in whole or inpart, that is said to be incorporated by reference herein isincorporated herein only to the extent that the incorporated materialsdoes not conflict with existing definitions, statements, or otherdisclosure material set forth in this disclosure. As such, and to theextent necessary, the disclosure as explicitly set forth hereinsupersedes any conflicting material incorporated herein by reference.Any material, or portion thereof, that is said to be incorporated byreference herein, but which conflicts with existing definitions,statements, or other disclosure material set forth herein will only beincorporated to the extent that no conflict arises between thatincorporated material and the existing disclosure material.

Various aspects of the subject matter described herein are set out inthe following numbered clauses:

1. An electrosurgical system for providing an electrosurgical signal toa patient, the system comprising:

a control circuit programmed to:

-   -   for a first application period, apply the electrosurgical signal        to first and second electrodes according to a first mode,        wherein in the first mode, the control circuit limits the        electrosurgical signal to a first maximum power when the        impedance between the first and second electrodes exceeds a        first mode threshold; and    -   for a second application period after the first application        period, apply the electrosurgical signal according to a second        mode, wherein in the second mode, the control circuit limits the        electrosurgical signal to a second mode maximum power when the        impedance between the first and second electrodes exceeds a        second mode threshold, wherein the second maximum power is        greater than the first maximum power.

2. The electrosurgical system of clause 1, wherein the first modethreshold is less than the second mode threshold.

3. The electrosurgical system of clause 1, wherein the control circuitis further programmed to:

for a third application period after the second application period,apply the electrosurgical signal according to a third mode, wherein inthe third mode, the control circuit limits the electrosurgical signal toa third maximum power when the impedance between the first and secondelectrodes exceeds a third mode threshold.

4. The electrosurgical system of clause 3, wherein in the third mode,the control circuit limits the electrosurgical signal to the thirdmaximum power when the impedance between the first and second electrodesexceeds a third mode threshold during an application period of a firstsub-mode, and wherein the control circuit is further programmed to:

for a fourth application period after the third application period,apply the electrosurgical signal according to a second sub-mode, whereinin the second sub-mode, the control circuit limits the electrosurgicalsignal to a fourth maximum power when the impedance between the firstand second electrodes exceeds the third mode threshold, wherein thefourth maximum power is greater than the third maximum power.

5. The electrosurgical system of clause 4, wherein the control circuitis further programmed to:

for a fifth application period after the fourth application period,apply the electrosurgical signal according to a third sub-mode, whereinin the third sub-mode, the control circuit limits the electrosurgicalsignal to a fifth maximum power when the impedance between the first andsecond electrodes exceeds the third mode threshold, wherein the fifthmaximum power is greater than the fourth maximum power.

6. The electrosurgical system of clause 3, wherein the control circuitis programmed to continue the third application period until theimpedance between the first and second electrodes reaches a terminalthreshold.

7. The electrosurgical system of clause 1, wherein the control circuitlimits the electrosurgical signal to the first maximum power by limitingthe electrosurgical signal to a first maximum voltage.

8. The electrosurgical system of clause 1, wherein in the first mode,the control circuit also limits the electrosurgical signal to a secondfirst-mode maximum power when the impedance between the first and secondelectrodes exceeds a second first-mode threshold.

9. The electrosurgical system of clause 1, wherein the control circuitis further programmed to apply the electrosurgical signal during thefirst mode as a plurality of pulses.

10. The electrosurgical system of clause 1, wherein the control circuitis further programmed to:

after the first and second application periods, determine whether a newtissue bite has been initiated; and

upon determining that a new tissue bite has been initiated, apply theelectrosurgical signal to the first and second electrodes according tothe first mode.

11. A method for providing an electrosurgical signal to a patient usingan electrosurgical system, the method comprising:

for a first application period, applying the electrosurgical signal tofirst and second electrodes of the electrosurgical system according to afirst mode, wherein in the first mode, the electrosurgical signal islimited to a first maximum power when the impedance between the firstand second electrodes exceeds a first mode threshold; and for a secondapplication period after the first application period, applying theelectrosurgical signal according to a second mode, wherein in the secondmode, the electrosurgical signal is limited to a second mode maximumpower when the impedance between the first and second electrodes exceedsa second mode threshold, wherein the second maximum power is greaterthan the first maximum power.

12. The method of clause 11, wherein the first mode threshold is lessthan the second mode threshold.

13. The method of clause 11, further comprising:

for a third application period after the second application period,applying the electrosurgical signal according to a third mode, whereinin the third mode, the electrosurgical signal is limited to a thirdmaximum power when the impedance between the first and second electrodesexceeds a third mode threshold.

14. The method of clause 13, wherein in the third mode, theelectrosurgical signal is limited to the third maximum power when theimpedance between the first and second electrodes exceeds a third modethreshold during an application period of a first sub-mode, and furthercomprising:

for a fourth application period after the third application period,applying the electrosurgical signal according to a second sub-mode,wherein in the second sub-mode, the electrosurgical signal is limited toa fourth maximum power when the impedance between the first and secondelectrodes exceeds the third mode threshold, wherein the fourth maximumpower is greater than the third maximum power.

15. The method of clause 14, further comprising:

for a fifth application period after the fourth application period,applying the electrosurgical signal according to a third sub-mode,wherein in the third sub-mode, the electrosurgical signal is limited toa fifth maximum power when the impedance between the first and secondelectrodes exceeds the third mode threshold, wherein the fifth maximumpower is greater than the fourth maximum power.

16. The method of clause 13, further comprising continuing the thirdapplication period until the impedance between the first and secondelectrodes reaches a terminal threshold.

17. The method of clause 11, wherein the electrosurgical signal islimited to the first maximum power by limiting the electrosurgicalsignal to a first maximum voltage.

18. The method of clause 11, wherein in the first mode, theelectrosurgical signal is also limited to a second first-mode maximumpower when the impedance between the first and second electrodes exceedsa second first-mode threshold.

19. The method of clause 11, further comprising applying theelectrosurgical signal during the first mode as a plurality of pulses.

20. The method of clause 11, further comprising:

after the first and second application periods, determining whether anew tissue bite has been initiated; and

upon determining that a new tissue bite has been initiated, applying theelectrosurgical signal to the first and second electrodes according tothe first mode.

1-20. (canceled)
 21. An electrosurgical system, comprising: an endeffector, comprising: a first jaw comprising a first electrode; and asecond jaw comprising a second electrode, wherein the second jaw ismovable relative to the first jaw between an open configuration and aclosed configuration; and a control circuit, configured to: receive aninput indicating a repeat mode; apply a first tissue bite algorithm tothe first electrode and the second electrode based on an occurrence of afirst tissue bite; enter a hold state at a termination of the firsttissue bite algorithm; and determine an occurrence of a second tissuebite.
 22. The electrosurgical system of claim 21, wherein the controlcircuit is configured to determine the occurrence of the second tissuebite by determining a reduction in impedance between the first electrodeand the second electrode.
 23. The electrosurgical system of claim 21,wherein the control circuit is configured to determine the occurrence ofthe second tissue bite by monitoring movement of a jaw closure triggerto an open position and then to a closed position.
 24. Theelectrosurgical system of claim 21, wherein the control circuit isfurther configured to apply a second tissue bite algorithm to the secondtissue bite based on the occurrence of the second tissue bite.
 25. Theelectrosurgical system of claim 24, wherein the control circuit isfurther configured to enter the hold state at a termination of thesecond tissue bite algorithm.
 26. The electrosurgical system of claim21, wherein the control circuit is further configured to terminate therepeat mode based on no occurrence of the second tissue bite within apredetermined amount of time after entering the hold state.
 27. Theelectrosurgical system of claim 21, wherein the control circuit isfurther configured to terminate the repeat mode based on an occurrenceof a jaw closure trigger remaining stationary for a predetermined amountof time after entering the hold state.
 28. The electrosurgical system ofclaim 21, wherein entering the hold state comprises maintaining a drivesignal at a sub-therapeutic level.
 29. An electrosurgical system,comprising: an end effector, comprising: a first jaw comprising a firstelectrode; and a second jaw comprising a second electrode, wherein thesecond jaw is movable relative to the first jaw between an openconfiguration and a closed configuration; and a control circuit,configured to: receive an input indicating a repeat mode; activate atissue bite algorithm based on an occurrence of a first tissue bite,wherein the tissue bite algorithm is configured to: measure a tissuecondition; apply an electrosurgical signal to the first and secondelectrodes to apply preparation energy to tissue; apply theelectrosurgical signal to the first and second electrodes to applysecondary energy to the tissue while a cutting member cuts the tissue;and apply the electrosurgical signal to the first and second electrodesto apply to apply post-cut energy to the tissue; enter a hold state at atermination of the tissue bite algorithm; and determine an occurrence ofa second tissue bite.
 30. The electrosurgical system of claim 29,wherein the control circuit is configured to determine the occurrence ofthe second tissue bite by determining a reduction in impedance betweenthe first electrode and the second electrode.
 31. The electrosurgicalsystem of claim 29, wherein the control circuit is configured todetermine the occurrence of the second tissue bite by monitoringmovement of a jaw closure trigger to an open position and then to aclosed position.
 32. The electrosurgical system of claim 29, wherein thecontrol circuit is further configured to active the tissue bitealgorithm based on the occurrence of the second tissue bite.
 33. Theelectrosurgical system of claim 29, wherein the control circuit isfurther configured to exit the repeat mode based on no occurrence of thesecond tissue bite within a predetermined amount of time after enteringthe hold state.
 34. The electrosurgical system of claim 29, wherein thecontrol circuit is further configured to exit the repeat mode based onan occurrence of a jaw closure trigger remaining stationary for apredetermined amount of time after entering the hold state.
 35. Theelectrosurgical system of claim 29, wherein entering the hold statecomprises maintaining the electrosurgical signal at a sub-therapeuticlevel.
 36. An electrosurgical system, comprising: an end effector,comprising: a first jaw comprising a first electrode; and a second jawcomprising a second electrode, wherein the second jaw is movablerelative to the first jaw between an open configuration and a closedconfiguration; and a control circuit, configured to: receive an inputindicating a repeat mode; activate a tissue bite algorithm based on anoccurrence of a first tissue bite, wherein the tissue bite algorithm isconfigured to: apply an electrosurgical signal to the first and secondelectrodes for a first application period, wherein the electrosurgicalsignal is limited to a first maximum power when impedance between thefirst and second electrodes exceeds a first threshold; and apply theelectrosurgical signal to the first and second electrodes for a secondapplication period, wherein the electrosurgical signal is limited to asecond maximum power when the impedance between the first and secondelectrodes exceeds a second threshold, wherein the second maximum poweris greater than the first maximum power; enter a hold state at atermination of the tissue bite algorithm; and determine an occurrence ofa second tissue bite.
 37. The electrosurgical system of claim 36,wherein the control circuit is configured to determine the occurrence ofthe second tissue bite by determining a reduction in impedance betweenthe first electrode and the second electrode.
 38. The electrosurgicalsystem of claim 36, wherein the control circuit is further configured toactive the tissue bite algorithm based on the occurrence of the secondtissue bite.
 39. The electrosurgical system of claim 36, wherein thecontrol circuit is further configured to terminate the repeat mode basedon no occurrence of the second tissue bite within a predetermined amountof time after entering the hold state.
 40. The electrosurgical system ofclaim 36, wherein entering the hold state comprises maintaining theelectrosurgical signal at a sub-therapeutic level.